SANDRA CUSTODIO AG-PCNP
NPI 1669886396
Nurse Practitioner - Acute Care in Charlottesville, VA

Q: What is Sandra Custodio's NPI number?

The NPI number for Sandra Custodio is 1669886396. It was assigned to this individual provider in the NPPES registry on June 20, 2014.

Q: What is Sandra Custodio's specialty?

The primary specialty registered for this NPI is Nurse Practitioner, specializing in Acute Care, with taxonomy code 363LA2100X.

Q: When was this NPI record last updated?

The NPPES record for Sandra Custodio was last updated on January 24, 2025. NPI Profile syncs weekly with the NPPES registry data releases published by CMS. This NPI record was last updated 18 months ago. If this record has changed at CMS more recently, you can request an on-demand re-check against the live CMS registry, directly from this page.

Active since June 20, 2014PECOS EnrolledAccepts Medicare Assignment

415 RAY C HUNT DR STE 2200, CHARLOTTESVILLE, VA 22903(434) 924-5700 Get Directions Write a Review

NPPES record last updated: January 24, 2025. Verified against the NPPES registry weekly; last sync: August 09, 2026.

Record update history: Aug 4, 2020, Jul 9, 2020 (2 updates tracked since 2020).

On this page

About Sandra Custodio Ag-pcnp NPPES

Official registry information on file with the National Plan and Provider Enumeration System.

SANDRA CUSTODIO AG-PCNP (NPI 1669886396) is an individual acute care provider in Charlottesville, Virginia, licensed in Virginia (0024189672) and active in the NPI registry since June 2014. She is enrolled in Medicare PECOS, is affiliated with University Of Virginia Medical Center, and maintains 2 additional practice locations.

NPPES Registry Identity

NPI1669886396

Entity TypeIndividualFemale

Primary Taxonomy363LA2100X

Provider Legal NameSANDRA CUSTODIOCredential: AG-PCNP

Location Address415 RAY C HUNT DR STE 2200Charlottesville, VA 22903-2980

Mailing AddressPo Box 749112Atlanta, GA 30374-9112 · (434) 295-1000

Phone(434) 924-5700

Sole ProprietorNo

Medical School CMSOtherGraduated 2000

Enumeration DateJune 20, 2014

Last NPPES UpdateJanuary 24, 20252 updates tracked since enumeration

NPPES CertifiedJanuary 24, 2025

✔ NPI 1669886396 is a valid, active identifier and passes the ISO check-digit test.

Specialties & Licenses 4

★ Primary SpecialtyNurse Practitioner · Acute CarePhysician Assistants & Advanced Practice Nursing Providers

Taxonomy Code363LA2100X

License✔ Licensed in VA · 0024189672

Also ListedRegistered NurseTaxonomy 163W00000X · License RN2328892 (MA)

Also ListedInternal Medicine · Infectious DiseaseTaxonomy 207RI0200X · License 0024189672 (VA)

Also ListedNurse Practitioner · Adult HealthTaxonomy 363LA2200X · License RN2328892 (MA)

415 RAY C HUNT DR STE 2200, Charlottesville, VA 22903

Open in Google Maps ↗

Secondary Practice Locations 2

Location 11215 Lee StCharlottesville, VA 22908-6232 · Phone (434) 982-1700 · Fax (434) 244-4480

Location 21300 Jefferson Park AveCharlottesville, VA 22903-3363 · Phone (434) 982-1700 · Fax (434) 244-4480

Medicare Participation & PECOS CMS

Medicare enrollment, assignment, and ordering and referring status from the CMS PECOS system.

Medicare Enrollment Status

✔

Enrolled in Medicare and accepts Medicare assignment

Sandra Custodio Ag-pcnp is registered in PECOS and agrees to accept the Medicare-approved amount as full payment. Medicare patients are not billed beyond the standard deductible and coinsurance.

PECOS PAC ID244642825

PECOS Enrollment IDI20240423001951

Eligible to Order & Refer✔ Part B Labs & Imaging✔ Durable Medical Equipment✔ Home Health Agency✔ Power Mobility DevicesPer the CMS Ordering and Referring file. Eligibility means Medicare pays claims that this provider orders or refers for these categories.

Areas of Expertise CMS Part B claims 3

Services this provider delivered to Medicare fee-for-service patients, from the CMS Medicare utilization data. Higher counts generally reflect more experience with a service; care delivered outside Medicare is not included.

Hemoglobin a1c level 83036

Hemoglobin A1c (HbA1c) is a test that measures your average blood sugar level over the past 2-3 months. It's used to monitor how well diabetes is being controlled. High levels may indicate that your diabetes treatment plan needs adjustment.

24 services24 patients

Established patient office or other outpatient visit with moderate level of decision making, if using time, 30 minutes or more 99214

This is a routine check-up for patients who have previously visited our clinic. It involves a comprehensive review of your health and any ongoing treatments. The consultation lasts between 30-39 minutes, allowing enough time to discuss any concerns.

15 services12 patients

Established patient office or other outpatient visit with high level of medical decision making, if using time, 40 minutes or more 99215

This service involves a follow-up appointment for existing patients, lasting between 40 to 54 minutes. During this time, your healthcare provider will assess your current health status, discuss any changes or concerns, review your treatment plan, and answer any questions you may have.

12 services11 patients

Hospital Affiliations CMS Care Compare

Hospitals where this provider delivers care, identified from recent Medicare claims and place-of-service records.

University Of Virginia Medical Center

Acute Care Hospitals · Charlottesville, VA

4/5 CMS rating

OwnershipGovernment - State

CMS Certification Number490009

Location1215 Lee StreetCharlottesville, VA 22908 · Charlottesville City County

Emergency services Birthing friendly

Physician Visit Costs CMS claims · ZIP area

Typical Medicare office-visit costs in the 22903 ZIP code area, from fee-for-service claims. These are area statistics, not this provider’s prices; actual charges vary by service and coverage.

New Patient

$86.88 typical visit price

range $56.19 – $170.30

Typical copayment $21.72 (range $14.04 – $42.57)

Most-billed visit code 99203

Established Patient

$99.13 typical visit price

range $18.07 – $138.91

Typical copayment $24.78 (range $4.51 – $34.72)

Most-billed visit code 99214

Amounts reflect what Medicare beneficiaries in this ZIP area are typically charged for office visits. Patients with other coverage should check their individual plans.

Referred Medical Equipment & Supplies CMS DME claims 3

Durable medical equipment, devices and supplies this provider ordered from DME suppliers for patients, from Medicare fee-for-service claims.

Blood glucose test or reagent strips for home blood glucose monitor, per 50 strips A4253

DME-Other DME · category DE017N

11 suppliers37 claims86 services$4.59 avg. paid by Medicare

Lancets, per box of 100 A4259

DME-Medical/Surgical Supplies · category DA000N

7 suppliers14 claims19 services$0.83 avg. paid by Medicare

Supply allowance for therapeutic continuous glucose monitor (cgm), includes all supplies and accessories, 1 month supply = 1 unit of service K0553

DME-Other DME · category DE017N

2 suppliers14 claims14 services$185.40 avg. paid by Medicare

Dollar amounts are the average Medicare paid the supplier per service. They are not the cost to the patient.

Other Providers at the Same Location NPPES 14

Providers registered at the same practice address, or within the immediate area, according to the NPPES registry.

WILLIAM M SWIFT MD

Otolaryngology